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People living with unruptured brain aneurysms may have an increased risk for mental health conditions such as anxiety and depression, a new study from South Korea suggests. The risk is especially high among people under 40.

The , published Monday in the ľ¹ÏÖ±²¥ journal Stroke, highlighted the need for better mental health support for people who have been diagnosed with aneurysms but whose conditions were only being monitored.

"As a neurosurgeon who treats cerebral aneurysms, I often see people who do not undergo surgery yet feel fear and/or anxiety about their condition before each imaging or screening test," study co-author Dr. Na-Rae Yang said in a . Yang is an assistant professor of neurosurgery at Ewha Womans University College of Medicine in Seoul, South Korea.

"Even when it is medically judged and explained that follow-up observation is the best course for their aneurysm rather than surgery, they still worry about the very slim chance of developing a fatal brain bleed," Yang said.

Unruptured intracranial aneurysms are weakened blood vessels in the brain that bulge, which can lead to a rupture and life-threatening brain bleed. An aneurysm can be diagnosed through imaging, such as a CT scan or MRI, to evaluate neurological symptoms, including headaches or vision changes. Roughly 168 million people worldwide have unruptured brain aneurysms.

Research shows up to 67% of brain aneurysm ruptures are fatal. Even when they are not, the ruptures can cause long-term disability. Because the risk for rupture is often low, many factors are considered when deciding whether to perform surgery or monitor a patient instead. These include the size and location of the aneurysm as well as the person's age and overall health. Yang and her team did not look at why the patient's aneurysm was untreated.

"We included all diagnosed, untreated brain aneurysms that were being followed," Yang said. "The reason for not treating and only following up may be that the aneurysm is small and unlikely to rupture, making treatment unnecessary. However, the decision is likely based on various circumstances."

Researchers analyzed records from people in the National Health Information Database in South Korea who were treated by hospitals, clinics and pharmacies. Over 10 years of follow-up, the researchers compared the occurrence of mental illnesses among 85,438 adults diagnosed with unruptured aneurysms between 2011 and 2019 to that of 331,123 people without aneurysms who were treated for acute upper respiratory infections during the same time period. Members of each group were matched by age, sex, economic status and other health conditions. Participants in both groups were an average 56 years old.

Mental health conditions in the study included anxiety, stress, depression, bipolar disorder, eating disorders, insomnia and alcohol or substance misuse. People diagnosed with a pre-existing mental health condition were excluded from the study.

Compared to people without an aneurysm, those with unruptured aneurysms were 10% more likely to be diagnosed with a mental health condition. The risk was highest in people under 40 and was three times higher when a psychiatrist diagnosed the mental health condition.

The higher rate of severe mental health issues among younger adults with aneurysms shows how much of a psychological burden they face, Yang said. They might already be dealing with other life stressors, such as starting their career or raising a family.

"This elevated rate of mental health conditions suggests that younger people might be particularly vulnerable, highlighting the need for targeted mental health support and interventions for this age group," she said. "This includes providing clear explanations and tailoring treatment decisions for each person."